Abstract
Perioperative ischaemia is a common cause of cardiac morbidity and cardiac death during perioperative period in patient with coronary artery disease or with other risk factors. The incidence of perioperative ischaemia is about 20 to 70% in patient with coronary artery disease or coronary artery disease risk factors. Post operative cardiac events (the combined incidence of nonfatal myocardial infarction, unstable angina, heart failure and sudden cardiac death) vary between 5.5 to 53% and postoperative myocardial infarction varies between 1.4 to 43%. Prolonged ST- segment depression along with hypercoagulability caused by surgical stress, platelet activation, increased fibrinogen activity and decreased fibrinolytic activities may lead to coronary thrombosis, ischaemia, nonfatal infarction or sudden cardiac death. Patients with coronary stents especially before complete endothelialization of the stents are of high risk category for these complications. Anesthesiologist being a perioperative physician should understand safety issues of these patients to prevent from ischaemia, coronary thrombosis and subsequent infarction or sudden cardiac death. Risk identification, optimization, monitoring, diagnosis of the problem, prevention and management are very crucial during perioperative period to enhance the quality service and patient safety.Journal of Society of Anesthesiologists 2014 1(1): 40-48
Highlights
Article History Received Accepted Published on print Published onlineThe incidence of perioperative ischaemia in coronary artery disease (CAD) patient and CAD risk patients ranges upto 60%.1
Perioperative ischaemia is a common cause of cardiac morbidity and cardiac death during perioperative period in patient with coronary artery disease or with other risk factors
Prolonged perioperative ischaemia is the main cause of infarction and may go undetected if proper monitoring is not adopted
Summary
The incidence of perioperative ischaemia in coronary artery disease (CAD) patient and CAD risk patients ranges upto 60%.1. It varies about 20% during preoperative period, 25% during intraoperative period and 41% postoperatively. The reported incidence of postoperative cardiac events (the combined incidence of nonfatal myocardial infarction, unstable angina, congestive heart failure, cardiac death) varies between 5.5 and 53% and that of postoperative myocardial infarction between 1.4 and 38%.2. Perioperative ischaemia confers nine fold increase in ischemic events defined as cardiac death, nonfatal MI or unstable angina.[2] Over 50,000 patients each year sustain perioperative MI in United States of America (USA). The result will be an increase in myocardial oxygen consumption in presence of decreased delivery along with hypercoagulability may lead to myocardial infarction
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